Bisphosphonate utilization across the spectrum of eGFR

Titan, Silvia Maria de Oliveira; Laureati, Paola; Sang, Yingying; Chang, Alex R.; Evans, Marie; Trevisan, Marco; Levey, Andrew S.; Grams, Morgan E.; Inker, Lesley A.; Carrero, Juan Jesús

doi:10.1007/s11657-020-0702-2

Cited by 4 publications

(3 citation statements)

References 37 publications

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“…Although nephrotoxicity has traditionally been associated with the less-used injection formulations, a recent study of new oral bisphosphonate users from the UK and Spain observed a modest (15%) increased risk of CKD progression compared to non use [ 32 ]. In the USA, consecutive drug safety announcements by the FDA were followed by a significant decline in bisphosphonate use in recent years [ 33 , 34 ]. Nonnephrotoxic osteoporotic medications, such as denosumab, may be an alternative in some cases.…”

Section: Discussionmentioning

confidence: 99%

Use of nephrotoxic medications in adults with chronic kidney disease in Swedish and US routine care

Bosi

Gasparini

et al. 2021

Clinical Kidney Journal

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Background To characterize use of nephrotoxic medications in patients with CKD Stage G3-5 in routine care. Methods Cohorts of adults with confirmed CKD G3-5 undergoing routine care during January 1, 2016 through December 31, 2018 in two health systems (Stockholm CREAtinine Measurements [SCREAM], Stockholm, Sweden [N = 57,880]; and Geisinger, Pennsylvania, U.S. [N = 16,255]). We evaluated the proportion of patients receiving nephrotoxic medications within one year overall and by baseline kidney function, ranked main contributors, and examined the association between receipt of nephrotoxic medication and age, sex, CKD G-stages, comorbidities and provider awareness of the patient's CKD using multivariable logistic regression. Results During a one-year period, 20% (SCREAM) and 17% (Geisinger) of patients with CKD received at least one nephrotoxic medication. Among the top nephrotoxic medications identified in both cohorts were NSAIDs (given to 11% and 9% of patients in SCREAM and Geisinger, respectively), antivirals (2.5% and 2.0%) and immunosuppressants (2.7% and 1.5%). Bisphosphonate use was common in SCREAM (3.3%), and fenofibrates in Geisinger (3.6%). Patients with age < 65 years, women, or with CKD G3 were at higher risk of receiving nephrotoxic medications in both cohorts. Notably, provider awareness of a patient's CKD was associated with lower odds of nephrotoxic medication use (OR, 0.85; 95% CI, 0.80–0.90 in SCREAM and OR, 0.80; 95% CI, 0.72–0.89 in Geisinger). Conclusions One in five patients with CKD received nephrotoxic medications in two distinct health systems. Strategies to increase physician's awareness of patients’ CKD and knowledge of drug nephrotoxicity may reduce prescribing nephrotoxic medications and prevent iatrogenic kidney injury.

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Section: Discussionmentioning

confidence: 99%

Use of nephrotoxic medications in adults with chronic kidney disease in Swedish and US routine care

Bosi

Gasparini

et al. 2021

Clinical Kidney Journal

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“…Different prescription guidelines, formulary and cost restrictions across countries can be considered as natural experiments: if a medication is prescribed as first-line treatment for a particular condition in Sweden but second-line in the United Kingdom, replication of consistent adverse drug event relationships despite variation in prescribing practices provides greater confidence in results. Whenever the possibility has risen, collaborations with other health systems has made our work more solid and translatable [82][83][84].…”

Section: Beyond Kidney Diseasementioning

confidence: 99%

The Stockholm CREAtinine Measurements (SCREAM) project: Fostering improvements in chronic kidney disease care

Carrero

Elinder

2022

J Intern Med

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“…41 Bisphosphonates are less frequently prescribed in these latter populations, possibly due to concerns about toxicity, as these drugs are excreted by the kidney. 42 Reports of worsening kidney disease or kidney injury exist for most drugs in the bisphosphonate class, but larger observational trials have found oral bisphosphonates to be reasonably safe in advanced chronic kidney disease, though bisphosphonate users had a 14% higher risk of progression of chronic kidney disease. 43 Zoledronic acid, a potent intravenous form ulation, should be avoided if the eGFR is less than 30 mL/min/1.73 m 2 , in view of stronger associations with direct tubular injury, acute kidney injury, and worsened eGFR.…”

Section: Bone Antiresorptive Agentsmentioning

confidence: 99%

Extraosseous calcification in kidney disease

Bartolomeo

Tan

Fatica

2022

CCJM

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A consequence of chronic and end-stage kidney disease is a higher risk of calcium deposition in sites other than the bones. The authors of this review outline current understanding of the pathogenesis, presentation, diagnosis, and treatment of this group of disorders. KEY POINTSExtraosseous calcifi cation is a broad term that encompasses vascular calcifi cation, soft tissue calcifi cation, and calciphylaxis, all of which are seen in patients with end-stage kidney disease.The pathogenesis of extraosseous calcifi cation is an active process involving a complex interplay of abnormal electrolyte levels, cell differentiation, and dysregulation of many biochemical pathways.Vascular calcifi cation is predominantly diagnosed incidentally, while soft tissue calcifi cation and calciphylaxis are diagnosed on the basis of radiographic and clinical presentation, sometimes requiring biopsy.Management is based on low-quality evidence and includes maintaining a neutral calcium balance, correcting hyperphosphatemia, and controlling comorbidities. Surgical and other nonmedical therapies may help somewhat in managing calciphylaxis and soft tissue manifestations.

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Bisphosphonate utilization across the spectrum of eGFR

Cited by 4 publications

References 37 publications

Use of nephrotoxic medications in adults with chronic kidney disease in Swedish and US routine care

Use of nephrotoxic medications in adults with chronic kidney disease in Swedish and US routine care

The Stockholm CREAtinine Measurements (SCREAM) project: Fostering improvements in chronic kidney disease care

Extraosseous calcification in kidney disease

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